VEIN DISEASE
Vein problems are common in the U.S. and Europe. By age 50, nearly 40% of women and 20% of men develop significant varicose veins or other vein disorders. Leg pain, swelling, and ulcers caused by vein insufficiency are common reasons why many patients ache, lose time from work, and refrain from leisure activities. Spider veins are often unsightly, and result from excess leg vein pressure due to incompetent saphenous veins.
Varicose Veins:
Varicose veins are swollen veins that bulge under the skin in a winding and rope-like manner. Varicose veins are the result of blood refluxing (venous blood flowing from the heart back to the leg) from deeper faulty vein valves. Not only are Varicose veins not cosmetically pleasing, they can cause pain, throbbing, heaviness, leg cramps, skin discolorations, swelling and ulcers.
Varicose veins - which afflict 10% to 20% of all adults - are swollen, twisted, blue veins that are close to the surface of the skin. Because valves in them are damaged, they hold more blood at higher pressure than normal. That forces fluid into the surrounding tissue, making the affected leg swell and feel heavy.
Unsightly and uncomfortable, varicose leg veins can promote swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the leg but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, patient symptoms are likely to worsen with some possibly leading to venous ulceration.
What causes varicose veins? The normal function of leg veins - both the deep veins in the leg and the superficial veins - is to carry blood back to the heart. During walking, for instance, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart.
To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail (a cause of venous reflux), blood flows back into superficial veins and back down the leg, the excess blood and pressure results in veins enlarging and becoming varicose. The process is like blowing air into a balloon without letting the air flow out again - the balloon swells.
To succeed, treatment must stop this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which run up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.
Why does it occur more in the legs? Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, those vessels experience a great deal of pressure. If vein valves cannot handle it, the backflow of blood can cause the surface veins to become swollen and distorted.
Who is at risk for varicose veins? Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood clot forms). Women suffer from varicose veins more than men, and the incidence increases to 50% of people over age 50.
The above symptoms and unsightly veins in the skin are usually a sign of an underlying trunk vein abnormality. The saphenous veins are the major leg veins returning blood from the skin to the heart. These veins contain one-way valves which are supposed to direct blood flow toward the heart and prevent the blood column from falling back down the leg. The one-way valves do not function properly in most patients with vein abnormalities. Consequently, blood in the saphenous leg veins will fall back down to the ankle or to the next healthy valve. This causes increased pressure inside the veins, including the skin veins. The result is the appearance of spider veins and often larger varicose veins. Without proper treatment, chronic high vein pressures will cause permanent damage such as scarring and ulceration.
Spider Veins:
Spider veins or "telangiectasias" are dilated veins less than 2mm in diameter that lie just below the surface of the skin on the legs or face. Spider veins are blue, red, or purplish in color with a web-like or linear appearance and are not cosmetically pleasing. These spider veins are usually drain into larger vein not visible under the skin called Reticular veins. Spider veins may occur with or without varicose veins due to increased venous pressure.
A number of factors contribute to the development of spider veins, including heredity, pregnancy and other events that cause hormonal shifts, weight gain, occupations or activities that require prolonged sitting or standing, and the use of certain medications.
Spider veins usually take on one of three basic patterns. They may appear in a true spider shape with a group of veins radiating outward from a dark central point; they may be arborizing and will resemble tiny branch-like shapes; or they may be simple linear and appear as thin separate lines. Linear spider veins are commonly seen on the inner knee, whereas the arborizing pattern often appears on the outer thigh in a sunburst or cartwheel distribution.
Spider veins in men are not nearly as common as they are in women. Men who do have spider veins often do not consider them to be a cosmetic problem because the veins are usually concealed by hair growth on the leg. However, sclerotherapy is just as effective for men who seek treatment.
